%0 Journal Article
%T Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations
%A Andrew P. Loehrer
%A David C. Chang
%A George J. Chang
%A Zirui Song
%J General Information | Journal of Oncology Practice
%D 2018
%R https://doi.org/10.1200/JOP.2017.025684
%X INTRODUCTION Section: ChooseTop of pageAbstractINTRODUCTION <<METHODSRESULTSDISCUSSIONREFERENCES Disparities in access to optimal cancer care along racial and socioeconomic lines persist across the country.1-3 These disparities are driven by a myriad of factors, including patient insurance status and the hospital in which they receive definitive cancer operations. Patients who undergo surgery for cancer of the bladder, esophagus, pancreas, rectum, or lung have significantly better outcomes when they undergo procedures at hospitals with higher annual surgical volumes.4-8 Uninsured and underinsured patients are less likely to receive care at high-volume hospitals (HVHs) and have worse outcomes than otherwise-similar, privately insured patients.9-11 One important assumption of recent health care reform is that provision of adequate insurance would remove an important barrier to the access of high-quality care. Therefore, how the expansion of health insurance affects the site of care for complex cancer operations is a critical policy question in the United States. Newly insured patients may be better able to seek and receive care at HVHs. Conversely, patients may continue to receive care at the same hospitals regardless of insurance coverage. Hospitals and providers remain interested in how insurance expansion is influencing the payer mix, uncompensated care, and the operating margin.12,13 The 2006 Massachusetts health reform, a model for the Affordable Care Act, provides a unique natural experiment to study the implications of insurance expansion on the site of complex cancer operations. The Massachusetts law aimed primarily to increase access to care through expanded insurance coverage, including expansion of Medicaid eligibility, creation of a government-subsidized insurance program for low-income residents, and establishment of an individual mandate to require residents to carry some form of health insurance. Since its enactment, insurance coverage has increased to greater than 97% of the population; the majority of newly insured enrolled in either Medicaid or the newly created, subsidized Commonwealth Care.14-17 The expanded coverage has been associated with increased rates of discretionary procedures and increased rates of resection for pancreatic and colorectal cancers.18-20 However, it is unclear how this expansion influenced site of care for complex surgical procedures for cancer. The primary objective of this study was to evaluate changes in the utilization of HVHs after the 2006 Massachusetts health insurance expansion. A secondary objective was
%U http://ascopubs.org/doi/full/10.1200/JOP.2017.025684